D-H Withdraws ‘Magnet’ Application

Lebanon — Dartmouth-Hitchcock Medical Center has withdrawn an application to renew its designation as a “Magnet” hospital — a certification meant to recognize superior nursing services — after a survey showed patient and employee satisfaction did not sufficiently exceed national benchmarks.

As a result, DHMC will start its next work week without a trademarked assurance of health care quality that it has held for more than a decade.

“On Monday, all of our logos with the Magnet (designation) will come down,” said Deanna Orfanidis, a member of the interim leadership team overseeing DHMC nurses pending the arrival of a new chief nursing officer.

Rick Adams, a DHMC spokesman, said losing Magnet status would have “no impact on the standard of care and the kind of care and the quality of care we provide.”

The certification, which was granted to the Lebanon medical center in 2003 and renewed in 2009, is awarded by the American Nurses Credentialing Center, which is a subsidiary of the American Nurses Association. The ANA website describes the organization as a “full-service professional organization that represents the interests of the nation’s 3.1 million registered nurses.”

The ANCC’s Jan Moran, director of the Magnet program, said that employee and patient satisfaction are measured by a third-party vendor who compares an applicant to similar hospitals. The vendor interviews and surveys employees and patients and the results are “statistically analyzed and validated,” she said. Among the areas reviewed are professional development, care delivery staffing, safety, quality and interdisciplinary collaboration.

Orfanidis said at DHMC, patient satisfaction scores met or exceeded the benchmark in seven of the eight required three-month periods, but fell short in one period, she said. The measure of employee engagement “met (the benchmark) but did not outperform our peer organizations,” she said.

Orfanidis said that after the credentialing center requested additional documentation to support D-H’s pending renewal, executives decided to “purposefully pause and withdraw the application.” She stressed that D-H leadership continues to “support and aspire” toward re-acquiring the Magnet seal of approval.

A memo sent to Dartmouth-Hitchcock nurses on Wednesday by Darlene Saler, another member of the interim nurse leadership team, pledged to build upon a “solid foundation of nursing excellence across the D-H system and chart our course for a future Magnet designation.”

Gay Landstrom, D-H’s new chief nursing officer who is due to begin work later this month, “was also consulted and agreed with the decision” to drop the application, Saler said.

Not everyone thinks highly of the ANCC certification program.

“We believe Magnet is a joke anyway, and a waste of money,” said David Schildmeier, of the Massachusetts Nurses Association, an affiliate of National Nurses United, a rival to the ANA. He described Magnet as “a marketing ploy by ANA to get people to spend a lot of money.”

Instead of pursuing such designations, hospitals should increase nurses’ pay and staffing levels and take more substantive measures to improve health care quality, he said.

A recent article in the journal Medical Care found that Magnet designation was associated with both higher inpatient costs and higher net inpatient revenues. Among hospitals surveyed, Magnet hospital costs were 2.5 percent higher than in uncertified hospitals but the steeper costs might be “offset by higher net inpatient income,” according to an abstract. Revenue was 3.9 percent higher in Magnet hospitals.

Orfanidis said the cost of applying for the Magnet designation varied with the size of the applying organization, and added, “This wasn’t really about money.”

In 1994, the University of Washington Medical Center in Seattle was the first hospital to win certification from ANCC. By 2011, 6.6 percent of the hospitals in the United States sported the Magnet logo.

According to the ANCC web site, three other New Hampshire hospitals — Exeter Hospital in Exeter and Southern New Hampshire Medical Center and St. Joseph Hospital in Nashua — have Magnet certification. Two Vermont hospitals, Rutland Regional Medical Center in Rutland and Southwestern Vermont Medical Center in Bennington, do as well.

For now, Dartmouth-Hitchcock, which employs 1,400 registered nurses in Lebanon and at its four clinics elsewhere in New Hampshire, has fallen off that list.

“For the community of nurses,” Orfanidis said, “this is a disappointment.”